- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $5,888.44 / $13,803.84
| Facility | | $1,905.46 | $5,888.44 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $4,897.79 / $13,182.57
| Professional | | $1,230.27 | $4,897.79 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $7,585.78 / $15,488.17
| Facility | | $3,311.31 | $7,585.78 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,584.89 / $3,467.37
| Professional | | $1,230.27 | $1,584.89 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $758.58 / $50,118.72
| Facility | | $323.59 | $758.58 | $50,118.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $3,162.28 / $10,232.93
| Facility | | $812.83 | $3,162.28 | $10,232.93 |